U-Lite - Questionnaire

To be assessed for pre-diabetes we will need the information below completed. You will then be asked a number of questions and shown the results of your likelihood of being pre-diabetic. Please note this is only an assessment. To have definitive determination of whether you are Pre-Diabetic, you will need to see your healthcare practitioner who may decide to do a blood test.

Many times people are being told that they are pre-diabetic. The truth however, is that for many people they are no longer “pre”, but in fact have diabetes. The term for pre-diabetes is misleading, as it implies a state before the disease really gets started; this is an unfortunate designation because pre-diabetes is really an earlier stage in the disease continuum – as in many instances some damage has already been done!

Pre-diabetes has two formal definitions. One definition for pre-diabetes is having a blood sugar reading between 100 and 125 mg/dl in the fasting (i.e. no food for 10-12 hours) state (1). This type of pre-diabetes is called “impaired fasting glucose” or IFG.

The other definition is based on doing an oral glucose tolerance test (OGTT); an OGTT involves drinking a sugary solution and testing blood sugar once per hour for several hours following the beverage. Based on an OGTT, pre-diabetes is defined as having a blood sugar between 150 and 199 mg/dl 2-hours after the test.1 This type of pre-diabetes is called “impaired glucose tolerance” or IGT.

Why would you do an OGTT if you can tell based on a simple blood test?

Different people can present with pre-diabetes differently, depending on which tissues in the body become resistant to insulin first. If the liver becomes resistant to insulin first, then a fasting blood test is enough. If the muscles become resistant to insulin first, then an OGTT may be necessary to know for sure whether pre-diabetes is present. How do you know, which comes first? Well we do not always know, but we do know that people from some ethnic backgrounds, including Black Americans, Latino Americans and Asian Americans, may develop IGT before IFG.

Can I get a hemoglobin A1c test to tell if I have pre-diabetes?

Although the hemoglobin A1c (HbA1c) test is used to monitor blood sugar over longer periods of time, it is not the definitive test for detecting pre-diabetes. That said, if you receive an abnormal HbA1c test - say greater than 6-6.5% - then pre-diabetes is highly likely.

How common is pre-diabetes & how do I find out if I have it?

The American Diabetes Association estimates that 57 million people in the United States have pre-diabetes, or approximately 19% (1/5) of the population! Unfortunately, it is estimated that up to 50% of these people do not know they have the condition.

Testing for pre-diabetes is easy, and the first step requires only a fasting blood test at your doctor’s office. If you are a member of an ethnic group at higher risk for developing impaired glucose tolerance (see above), then you should ask to schedule an OGTT instead of just a fasting blood test.

Home glucometers should not be used to try and test for pre-diabetes at home because at your doctor’s office the blood sugar is tested from blood in your veins, which is slightly different from the blood in the small capillaries you use with a home glucometer. Also home glucometers have a lot of variability in their readings day-to-day and even minute-to-minute. If you are going to test for pre-diabetes, it is better to make the test more definitive.

Why is finding out about pre-diabetes important?

The obvious answer is that finding out about pre-diabetes is important so that you can take steps to prevent developing full-blown diabetes. Because type 2 diabetes greatly contributes to the risk of developing heart disease, kidney disease requiring dialysis, adult-onset blindness and amputation, identifying risk for diabetes, and preventing diabetes is very important for long-term health.

Type 2 diabetes is preventable. The Diabetes Prevention Program (DPP) was a 3-year clinical trial that definitively showed type 2 diabetes can be prevented by losing weight and adopting a healthier lifestyle (3). In the absence of lifestyle changes, the majority of people who develop pre-diabetes will continue on to develop type 2 diabetes. Even if medications are used in the short-term to prevent diabetes, what happens in 3-5 years when the medication isn’t working anymore? The progression of diabetes is well established; the disease does not simply plateau, rather it continues to worsen, requiring more and more medication, and ultimately insulin injections.

How was diabetes prevented in the DPP?

Diabetes was prevented in the DPP by altering the diet of participants and increasing exercise levels. The two main goals of the DPP intervention were to lose and maintain 7% of the participants’ body weight and to increase physical activity in participants to the recommended 150 minutes per week. When the results were analyzed, weight loss during the study was the greatest predictor of preventing diabetes; for every 2.2 pounds of weight loss, there was a corresponding reduction in risk for diabetes of 16%, or almost a 60% reduction for each 11 pounds of weight lost. In the DPP, meeting exercise goals of 150 minutes per week and reducing food calories that come from fat in the diet were both predictors of reaching the weight loss goals set in the study.

Conclusions

Although pre-diabetes does precede diabetes, it is an earlier step in the continuum of the disease process, not a disease-free state. Without weight loss and lifestyle change, pre-diabetes will progress and become type 2 diabetes, a leading cause of heart disease, blindness and kidney disease. Over time, even drug treatments to “prevent” diabetes will fail and more medications will be necessary to control the disease. Clinical research has definitively shown that type 2 diabetes can be prevented by lifestyle changes, including small reductions in weight (< 10% in most cases!). Physical activity to recommended levels (150 minutes per week) and making dietary choices now can prevent pre-diabetes from becoming type 2 diabetes. Knowing your blood sugar status can help you make the changes necessary to prevent diabetes now!